Left ventricular remodelling in rheumatic heart disease – trends over time and implications for follow-up in childhood

BMC Cardiovascular Disorders

Research

Deane Yim¹  David Andrews¹  James Ramsay¹  Louise Causer¹  Di Bruce¹  Adrian Tarca¹  Katie Maslin¹  Rachel Schreiber-Wood¹  Bradley MacDonald²  Jonathan Carapetis³  Asha C. Bowen³  Mark K. Friedberg⁴  Mohit Kumar⁵  Charley Budgeon⁵  Judith Katzenellenbogen⁶ 

[1] Children’s Cardiac Centre, Department of Infectious Diseases, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, 6008, Perth, WA, Australia;Children’s Cardiac Centre, Department of Infectious Diseases, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, 6008, Perth, WA, Australia;School of Population and Global Health, University of Western Australia, Perth, Australia;Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid’s Institute, University of Western Australia, Perth, Western, Australia;Children’s Cardiac Centre, Department of Infectious Diseases, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, 6008, Perth, WA, Australia;Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid’s Institute, University of Western Australia, Perth, Western, Australia;Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada;School of Population and Global Health, University of Western Australia, Perth, Australia;School of Population and Global Health, University of Western Australia, Perth, Australia;Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kid’s Institute, University of Western Australia, Perth, Western, Australia;

关键词: Rheumatic heart disease (RHD);    Left ventricular remodelling;    Left ventricle volume;   

DOI  :  10.1186/s12872-023-03497-0

 received in 2023-06-14, accepted in 2023-09-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundRheumatic heart disease (RHD) is the most common form of acquired heart disease worldwide. In RHD, volume loading from mitral regurgitation leads to left ventricular (LV) dilatation, increased wall stress, and ultimately LV dysfunction. Improved understanding of LV dynamics may contribute to refined timing of intervention. We aimed to characterize and compare left ventricular remodelling between rheumatic heart disease (RHD) severity groups by way of serial echocardiographic assessment of volumes and function in children.MethodsChildren with RHD referred to Perth Children’s Hospital (formally Princess Margaret Hospital) (1987–2020) were reviewed. Patients with longitudinal pre-operative echocardiograms at diagnosis, approximately 12 months and at most recent follow-up, were included and stratified into RHD severity groups. Left ventricular (LV) echocardiographic parameters were assessed. Adjusted linear mixed effect models were used to compare interval changes.Results146 patients (median age 10 years, IQR 6–14 years) with available longitudinal echocardiograms were analysed. Eighty-five (58.2%) patients had mild, 33 (22.6%) moderate and 28 (19.2%) severe RHD at diagnosis. Mean duration of follow-up was 4.6 years from the initial diagnosis. Severe RHD patients had significantly increased end-systolic volumes (ESV) and end-diastolic volumes (EDV) compared to mild/moderate groups at diagnosis (severe versus mild EDV mean difference 27.05 ml/m2, p < 0.001, severe versus moderate EDV mean difference 14.95 ml/m2, p = 0.006). Mild and moderate groups experienced no significant progression of changes in volume measures. In severe RHD, LV dilatation worsened over time. All groups had preserved cardiac function.ConclusionsIn mild and moderate RHD, the lack of progression of valvular regurgitation and ventricular dimensions suggest a stable longer-term course. Significant LV remodelling occurred at baseline in severe RHD with progression of LV dilatation over time. LV function was preserved across all groups. Our findings may guide clinicians in deciding the frequency and timing of follow-up and may be of clinical utility during further reiterations of the Australia and New Zealand RHD Guidelines.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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